On Rock Adventures Application Form

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					    On Rock Adventures Application for Admission 2009 Season
                                Stacie M. Sieloff, Owner & Director

Important Dates:
January 15, 2009
         - Last day for Early Bird Registration
March 31, 2009
         - Cancellations on or before this day result in a return of all payments except $250 of the $600
April 1, 2009
         - Full tuition due
         - Registration after April 1st requires a payment of tuition in full
         - Cancellations on or after April 1 results in a 100% loss of tuition
May 1, 2009
         - All camper forms are due

Cancellation Policy:
        -   All cancellations MUST be submitted in writing or via email
        -   Cancellations made prior to April 1st: All payments are returned except $250 of the $600
        -   Cancellations on or after April 1st results in loss of 100% of the tuition
        -   Late arrival or early departure: No Refund
        -   Camper sent home for disciplinary reason or homesickness: No Refund
        -   Camper sent home for not having a complete Health Form: No Refund

1. Call On Rock Adventures to confirm that there is space available and to determine if On Rock
Adventures and your session of choice are a good fit. Openings are available on a first come, first
served basis. Your space may be held with a verbal commitment for up to 7 days, at which date
your registration with deposit must be received in our office. Depending on availability, we may
only be able to hold your space for 24 hours, allowing for overnight delivery of registration
2. Read, complete and sign this Application, Registration and Terms of Agreement form and send
it in with your $600 deposit to:

On Rock Adventures
PO Box 23
Saranac Lake, NY 12983

Applicant and parent or legal guardian (if applicant is under 18 by camp date), must read,
complete and sign this Application, Registration and Terms of Agreement below. Incomplete
registration forms may be returned to you, resulting in delayed registration.

Participant Information:

Legal Name (first) ____________________________ (Middle)________________________ (Last) _________________________

(name you like to be called) __________________________________________________________________________________

Street Address ____________________________________________________________________________________________

City _______________________________ State _____________ Zip _________________ Home Phone ____________________

Camper Email _____________________________________________________________________________________________

Birth Date _______________________________ Age in June 2008 ________ Height ________________ Weight _____________

Father’s Name _________________________________________ Mother’s Name ______________________________________

Father’s Occupation _____________________________________ Mother’s Occupation __________________________________

Street Address (home) ___________________________________ Street Address (home) ________________________________

City _____________________ State ________ Zip ____________ City __________________ State _________ Zip ___________

Work Phone _______________ __Home Phone _______________ Work Phone ______________ Home Phone ______________

Cell Phone ____________________________________________ Cell Phone _________________________________________

Email ________________________________________________ Email _____________________________________________

Please indicate which trip you are applying for:
Choose your top 3 camp sessions and number 1-3:

___      Session 1         Wilderness         6/16/09 – 6/22/09
___      Session 2         Triathlon          6/24/09 – 6/30/09
___      Session 3         Wilderness         7/8/09 – 7/14/09
___      Session 4         Triathlon          7/15/09 – 7/21/09
___      Session 5         Wilderness         7/22/09 – 7/28/09
___      Session 6         Triathlon          7/29/09 – 8/4/09
___      Session 7         Wilderness         8/5/09 – 8/11/09
___      Session 8         Wilderness         8/12/09 – 8/18/09
___      Session 9         Wilderness         8/19/09 – 8/25/09

Please indicate your previous traveling and camping experiences ____________________________________________________


Did you attend Wellspring New York in 2007? Yes _______ No _______

How did you hear about On Rock Adventures? ___________________________________________________________________

Have you participated in an On Rock Adventures camp before? Yes _______ No _______ Dates: __________________________

Please explain any dietary restrictions __________________________________________________________________________

Are you attending with a friend? Yes _______ No _______ If yes, please name: ________________________________________

Friends/Relatives who may wish to receive our brochure:
Name ________________________________________________ Name _____________________________________________

Address ______________________________________________ Address ___________________________________________

City _____________________ State ________ Zip ____________ City ___________________ State ________ Zip ____________

Home Phone __________________________________________ Home Phone ________________________________________

Terms of Agreement:
Application and Registration process: Upon receipt of your registration form, application and $600
deposit, On Rock Adventures will email you confirmation and that will include printable forms including the
Health Form, Acknowledgment & Assumption of Risks Form and other relevant forms and information.
These forms contain important information associated with your On Rock Adventures experience, so
please read and complete these forms carefully. All forms must be completed and signed by participant
and parent/s, as appropriate. Final acceptance to the session is contingent on On Rock Adventure’s
receipt and review of all forms. In late May, On Rock Adventures will send a pre-camp letter and other
pertinent information.
Tuition and Terms of Payment: $250 of the $600 deposit is non-refundable. Remaining balance of
tuition is due APRIL 1. We do not accept credit cards. Registrations after April 1 are to be paid in full.
Overdue balances may result in forfeiture of your reserved space. The tuition includes all expenses once
you have arrived at the specified arrival site for your session except for the meals/shopping scheduled
during the triathlon camp in Lake Placid.
Cancellation, Alteration and Return: 1) $350 of your deposit received before April 1 is refundable,
$200 is non-refundable. Cancellations after April 1 results in loss of 100% of your tuition. 2) On Rock
Adventures will not refund or reduce tuition for late or non-arrival, early withdrawal or participant
cancellation for any cause. 3) On Rock Adventures reserves the right to cancel or alter any aspect of our
program, including program itinerary, trip dates, activities or location as a result of unforeseen
circumstances including weather, environment or health hazards. If On Rock Adventures cancels a trip,
your tuition paid will be refunded in full, but On Rock Adventures will not be held responsible for fees
associated with your canceled travel reservations or equipment purchased for the trip (including non-
refundable air tickets). 4) If camper is dismissed or departs for any reason (including choosing to return
home early from the program), no refunds can be granted and camper and parent/s are responsible for
any and all costs of early departure, whether for medical reasons, personal emergencies or otherwise.
These costs include, but may not be limited to: medical evacuation and costs, medical treatment, plane
train or other transportation costs or fares, meals, lodging and expenses for staff who may accompany
Costs and Insurance: On Rock Adventures is not responsible for (and On Rock Adventures insurance
will not cover) costs incurred or tuition refunds due to trip delay, cancellation, interruption or early
termination (as discussed above), medical treatment or evacuation on program or otherwise or costs
incurred from lost baggage, or lost, stolen or damaged personal belongings. You are required to have
medical/health insurance on your child. We highly recommend that parent/s consider purchasing
additionally medical and trip cancellation and/or travel insurance to cover these costs and/or losses, as
well as reviewing their own personal insurance to check and understand their coverages.
Camper Behavior & Expectations:
- Campers must abide by On Rock Adventure’s rules and policies
- Groups involve compromises to accommodate diverse desires, physical abilities and personalities of all
group members. On Rock Adventure Staff may be required to improvise and exercise its discretion to
make decisions that are intended to satisfy the desires of the larger group. Please understand that these
decisions will not always please each individual.
- Campers must be prepared for the rigors of camp life before they arrive at camp. These preparations
include dealing with challenging group dynamics, showing commitment to a group.
- Campers must be physically prepared for the rigors of camp athletic activity before their arrival. For
Wilderness Camp, these preparations including having hiking boots worn in, and exercising hard with a
full sweat for a minimum of 30 minutes 4-5 times each week at least one month before arriving to camp.
For the Triathlon Camp we ask that the girls train before arrival to be able to swim front or back crawl for
39 minutes non-stop, bike 77 minutes non-stop as well as run 39 minutes non-stop. A pre-Triathlon
Camp training schedule will be provided with confirmation of registration.
- Campers are expected to have a good attitude, keep track of their belongings, wear sunscreen daily,
drink lots of water and share in the responsibility for their own well-being and the well-being of the group.
- On Rock Adventures reserves the right to dismiss any camper from the program that staff believes, in
their discretion, presents a safety concern or medical risk, is disruptive or otherwise conducts herself in a
manner detrimental to the program. Conduct that On Rock Adventures considers detrimental to the
program and that can result in immediate dismissal includes, but is not limited to: use or distribution of

illegal drugs, alcohol or tobacco products, pregnancy, theft, falsifying medical records and/or not
disclosing medical conditions.
- Even if a camper is accepted in a program, it is ultimately up to the parent/s and their daughter, in
conjunction with the physician to decide whether an On Rock Adventures program is an acceptable
match for them. Please see the On Rock Adventures Health Form, and Acknowledgment and
Assumption of Risks for further details.
Equal Opportunity:
On Rock Adventures provides equal camp opportunities to all and does not discriminate regarding its
employees or campers on the basis of race, color, gender, religion, national or ethnic origin, sexual
orientation, age or disability. On Rock Adventures is not, however, a treatment center, and On Rock
Adventures Staff are not trained to deal with campers who have severe mental, physical or emotional
difficulties. We do reserve the right to refuse admission to our programs in appropriate cases.
Photo Permission/Release: Camper and her parent/s authorize On Rock Adventures and/or parties
designated by On Rock Adventures, to use photos, videos, recordings and/or written statements which
may include the camper or be taken of or by the camper, in any manner On Rock Adventures desires, for
advertising, display or other use without review of or compensation to camper or parent/s.
Lost, Stolen or Damaged Property: On Rock Adventures is not responsible for a camper’s lost, stolen
or damaged personal belongings. In addition, campers and their parent/s will be held responsible for
damage to, or loss of On Rock Adventures property or equipment. This may include sharing in the
group’s collective responsibility for willful equipment/property destruction or loss.

For all Campers & Parent/s: I have accurately completed this Application and have read, understand
and agree to the Terms outlined above. I agree to review all program materials sent, to complete all
required forms and to abide by the terms of those documents. The parent gives his/her child permission
to participate in all On Rock Adventures activities and programs. In the unlikely event that a dispute
cannot be settled through discussion, I agree that New York law (without regard to its conflict of laws
rules) will govern all aspects of campers’ or parent/s’ relationship with On Rock Adventures and that any
medication, suit or other dispute will be filed or entered into only in Franklin County, New York. A parent
must sign below if a camper is under 18 years of age.

Camper signature                                                                   Date

Parent or Guardian signature                                                       Date


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